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Utah rates for HCPCS 81404

Molecular pathology procedure, Level 5 (eg, analysis of 2-5 exons by DNA sequence analysis, mutation scanning or duplication/deletion variants of 6-10 exons, or characterization of a dynamic mutation disorder/triplet repeat by Southern blot analysis)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$175.00 / $175.00 / $388.73
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$175.00 / $175.00 / $175.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$234.91 / $241.61 / $757.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$126.34 / $295.27 / $502.64
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$274.83 / $316.05 / $1,113.06
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$274.83 / $304.48 / $382.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$115.43 / $115.43 / $164.90